Equine Therapy: What It Is, Benefits, & What to Expect

What Is Equine Therapy?

Equine therapy, also called equine assisted therapy (EAT), equine-facilitated therapy, horse therapy, equestrian therapy, or horse-riding therapy, is a therapeutic modality that utilizes horses to help people deal with physical and psychological challenges. Client, horse and trained horse specialists are able to work together on specific treatment plans using the horse in a number of different ways.

Similar to therapy dogs, horses are sensitive to non-verbal communication and remain mentally and physically prepared to respond to their environment in the present moment. Their overall surroundings dictate their behavior, which directly, or indirectly, alters the therapeutic narrative throughout an EAT session.

How Was Equine Therapy Developed?

Equine therapy dates back to ancient Greece, during which time Hippocrates wrote about riding horses as a therapeutic form of exercise. While equine therapy has long been utilized in treating physical illness through therapeutic riding, in more recent years horses have also been utilized in mental health care. While psychoanalyst Wilhelm Reich contributed to the modern use of horses in therapy back in the 20th century, equine therapy for mental health care began to be more widely recognized in the 1990s.¹

Types of Equine Therapy

There are several approaches to equine therapy, including:

• Equine Assisted Psychotherapy (EAP): This utilizes a mental health professional, an equine specialist, and horses all working together.
• Equine Assisted Learning (EAL): This is an experiential learning approach that promotes the development of life skills through equine assisted activities including grooming, feeding, and ground exercises.
• Hippotherapy: Hippotherapy is a form of physical, occupational and speech therapy in which a therapist uses the characteristic movements of a horse to provide carefully graded motor and sensory input.² This involves an occupational therapist, a physiotherapist, or a speech and language therapist working with a client and a horse.³
• Therapeutic Horseback Riding: This is a unique horse therapy approach that includes horseback riding and addresses the physical needs of the client.  This style uses a therapeutic team, usually including a certified therapeutic riding instructor, two or more volunteers, and a horse, to help an individual ride a horse and work with the horse on the ground.

What Conditions Are Treated With Equine Therapy?

Because horses are so in-tune with non-verbal cues in their environment, they can help aid people with a variety of issues, including mental, emotional and physical problems. The mutual building of trust through self-confidence, healthy communication, and mindfulness with such a large and powerful animal can aid in building or restoring healthy boundaries for those who have a history of abuse, trauma, neglect, and low self-esteem. This type of therapy can also be especially helpful in treating those who have trust and abandonment issues.

For some, working with a horse provides exercise for those who need help developing fine and gross motor skills. Hippotherapy allows others to stretch and activate organic muscle movements with the horse’s gait. People with different forms of cerebral palsy and autism can benefit from horseback riding, as it helps them develop strength, balance, and muscle control.

Equine assisted psychotherapy can also be used to treat the following conditions:

• Trauma, including abuse, and trauma related disorders such as PTSD and acute stress disorder
• Depression
• Anxiety or stress
• Addiction
• Relationship issues
• Co-occurring mental health and substance use disorders

Additionally, equine therapy can be used as a form of couples counseling, and for group and team building.

How Does Equine Therapy Work?

Equine therapy often begins with a comprehensive assessment led by the therapist, followed by weekly, hour-long therapy sessions. A typical session might include horse-care activities, such as grooming and feeding the horse the client is partnered with, followed by leading the horse, often in an arena or fenced outdoor space. The therapist and client will explore thoughts, feelings, sensations, and memories brought up through the client’s interaction with the horse.

The presence of the horse offers a unique opportunity to talk with a therapist in a less threatening environment, while the horse naturally mirrors the client’s affect and behavior, inviting them to process what they are experiencing in the moment with the therapist. The horse also acts as a vessel for projection, as the client may find it easier to discuss the horse’s behavior or emotional experience than their own. Finally, engaging in horse care activities offers the client an opportunity to build important skills, such as empathy, self-esteem, and social awareness.⁴

Equine Therapy Benefits

Equine assisted therapy can provide a number of therapeutic benefits to people who are challenged with both physical and mental health issues. Effective non-verbal communication with a horse requires emotional regulation and self-awareness. In turn, these healthy skills are transferred to other human relationships.⁵ Depending on what style of equine therapy is used, benefits may vary.

Calms the Nervous System

Research shows that spending time around horses helps to regulate the body’s nervous system. During equine therapy, endorphins, the body’s feel-good hormone, are released. This helps to calm an overactive nervous system that is affected by trauma, depression, or anxiety.⁶

Promotes Healthy Attachment

Many clients come to therapy with unhealthy attachment patterns in relationships. By forming a bond with a horse through the therapeutic process, a person may then be able to transfer their new, healthier attachment template to other relationships in their life. Taking on responsibility for some of the horse’s care each week can also inspire empathy and nurturing.

Cultivates Social Learning & Connection

Equine therapy can help cultivate social learning and connection in many ways. Studies have shown that adolescents in particular can gain valuable social skills from participating in equine therapy.⁷ With horses, clients can more comfortably communicate freely, and explore their own self-perception and behavior in relationship to the horse, with the support of the therapist.

Enhances the Client-Therapist Relationship

The secure bond that is formed between the client and the horse can also serve to strengthen the therapeutic relationship between the client and the therapist. This creates safety for open communication and healing as the therapeutic process unfolds.

Non-Judgmental & Unbiased

Horses are herd and prey animals conditioned to stay mindful in their current environment. This gives the horse a natural advantage over the rest of the therapeutic team by intuitively taking a non-judgmental and unbiased perspective to their therapeutic approach. That being said, the therapeutic team always takes into account possible transference and countertransference from all participants, including the horses, in a session.

Feedback & Mirroring

Another organic trait that horses bring to the team is their ability to mimic their environment and those that are interacting in it via their body language and other subtle mannerisms. The horse’s behavior reflects the client’s current emotional and physical state. This encourages the client to be more self-aware. This feedback from the horse’s behavior gives the equine specialist an opportunity to translate the shared language with the horse into useful information for the client and mental health professional to use while processing a session.

Nature & Ecotherapy

Ecotherapy recognizes and promotes the natural benefits of being outdoors, an extremely important component during EAT sessions. Many studies have shown the direct correlation between physical and mental health, and EAT addresses both. Our surroundings can affect the way we think and feel, and regular exposure to nature has also shown to be crucial for a healthy and meaningful quality of life. Reconnecting with nature has been shown to be beneficial for easing some of the symptoms of depression, anxiety, and stress. The very act of being in nature promotes mindfulness, gratitude, and balance. Being outside with the horses bestows a sense of connectedness, humility, and contentment.

Mindfulness

Mindfulness is the psychological process of purposefully bringing one’s attention to experiences occurring in the present moment without judgment. Mindful meditation with horses helps in reducing reactions to stress by inducing the relaxation response, lowering the heart rate, reducing anxiety, and encouraging positive thought patterns and attitudes.⁸ Horses can also help others to focus on breathwork and encourage positive attitudes to achieve a healthy and balanced mental state.

What to Consider Before Getting Started

If equine therapy seems like a good fit for you, pause to consider the following factors before making your first appointment with a provider.

Here are some factors to consider before starting equine therapy:

• Timing: Before getting started with equine therapy, consider if you have time to commit to the process. Often equine therapy takes place in rural areas outside of the city, making for a potentially longer commute to weekly therapy sessions. If you are in crisis, detoxing from substance use, or recovering from a recent injury or other medical issue, it may not be the right time to begin equine therapy.
• Fear: Horses are large animals, and some clients may feel a significant amount of fear around horses. If someone has a traumatic memory involving horses that might be triggered, equine therapy may also not be the best fit.
• Cost: Because equine therapy is a relatively new treatment modality with a small body of evidence, it is most often not covered by health insurance plans. Out-of-pocket costs for equine therapy can be expensive.
• Accessibility: This unique therapeutic intervention is not always easy to find, particularly for those living in the city.

Is Equine Therapy Effective?

Equine assisted therapy has proven to be beneficial for treating a variety of physical and mental health issues. Healthy brain connectivity significantly correlates with clinical mental health improvements, suggesting that enhanced reward responsiveness may underlie the improvements seen in subjects with PTSD after EAT treatment.

One study called, “The Man of War Project” demonstrated that in an eight-week course of EAT in subjects with PTSD, more positive changes were reported than in office talk therapy settings.⁹ Improving reward circuitry with the help of EAT might be significant to finding new and enhanced methods to treat this complex disorder.

Furthermore, the use of the natural world as a form of therapy has gained the interest of scientists, researchers, psychologists, and physicians for thousands of years. In 460 BC, the renowned Greek physician Hippocrates spoke about the benefits of horses in solving mental and physical health problems.

Risks of Equine Therapy

Physical and psychological safety concerns are taken into account before, during, and after each EAT session.

• Risk of vulnerability: One physical risk that all EAT participants take on are consequences for crossing physical and emotional boundaries, potentially making the individual feel vulnerable or even unsafe. This, however, presents a unique opportunity to address this important topic metaphorically throughout each session, which can help grow self-confidence and overcome certain fears.
• Risk of injury: Horses are large powerful animals that can cause injuries, especially if they’re not properly respected. In most cases, there will be an equine specialist present to monitor all physical safety aspects of each session. Release forms should be required to participate and will generally be included during intake documentation.
• Potential for inclement weather: It’s also always important to consider weather when preparing for an EAT session, and to check in with your therapist or facility about inclement weather condition policies.  Some arenas are covered and can still facilitate sessions.

Cost of Equestrian Therapy

The cost of equine assisted therapy sessions are dictated by the professional and vary depending on several variables. Each session usually costs slightly more than a typical office therapy appointment. Some of those variables include the type of EAT session, number of professionals on the treatment team (facilitators/specialists/horses), and the length of session.

Is Equine Therapy Covered by Insurance?

Some equine assisted therapy facilities and therapists accept insurance for therapy. EAT sessions are individualized and therefore are very client-specific. A fee agreement should be made before the first session.

How to Find an Equine Therapist

Professional counselors, therapists, equine trained specialists, and equine therapy facilities are beginning to provide services all over the world. Professional Association of Therapeutic Horsemanship International (PATH INT) and Equine Assisted Growth And Learning Association (EAGALA) are two credible organizations to contact when looking for a therapist and/or a facility.

The certification process to facilitate sessions differs depending on what type of EAT you’re looking for. Be sure to ask the treatment team for their credentials before entering the arena or approaching a horse. You can always contact a local boarding stable or co-op for other possible resources about general horse related questions.

What to Expect at Your First Appointment

Depending on the service provided, each equine therapist or facility will have their own intake process and consultation to be sure you are a qualified candidate before beginning treatment. Thereafter, each session is an organic process that is specifically tailored to each client, the horses, and the goals and objectives of the session. Interactions with horses should typically be expected during your first appointment, unless otherwise specified by the treatment team.

Like any other doctor or therapy appointment, you will fill out consent forms, review policies and procedures, as well as sign a safety waiver regarding barn rules and liability. Most facilities and practitioners will also provide clients with access to online treatment management.

Final Thoughts on Equine Therapy

Equine assisted therapy is becoming more and more popular, while various equine therapy modalities are adapting and improving. Horses have the power to positively impact the emotional, physical, cognitive, spiritual, and social well-being for many, and EAT sessions have the ability to enhance a client’s therapeutic experience. EAT can cater to anyone seeking an alternative, adventurous, and professional approach to traditional therapy.